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Individual

DR. RICHARD RAWLS RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
210 S ODOM ST, BASTROP, LA 71220-4631
(318) 281-2200
(318) 281-7359
Mailing address
210 S ODOM ST, BASTROP, LA 71220-4631
(318) 281-2200
(318) 281-7359

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
872-292T
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1308021
LA
01
2267B
BLUE CROSS BLUE SHIELD OF LOUISIANA
01
30048
UNITED COMMERCIAL TRAVELORS OF AMERICA
01
72128
VANTAGE HEALTH PLAN
01
98171
ARKANSAS BLUE CROSS BLUE SHIELD
Enumeration date
11/29/2006
Last updated
12/29/2008
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